Clinical Experience with Pancreas Graft Rescue From Severe Thrombus After Simultaneous Pancreas-Kidney Transplantation by Early Detection with Doppler Ultrasound: A Case Report
Unusual clinical course, Unusual or unexpected effect of treatment, Diagnostic / therapeutic accidents, Educational Purpose (only if useful for a systematic review or synthesis)
Mitsunobu Takeda, Daisaku Yamada, Hidetoshi Eguchi, Tadafumi Asaoka, Takehiro Noda, Hiroshi Wada, Kunihito Goto, Koichi Kawamoto, Yutaka Takeda, Masahiro Tanemura, Toshinori Ito, Masaki Mori, Yuichiro Doki
(Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka, Japan)
Am J Case Rep 2016; 17:899-904
Graft thrombosis is the main cause of early graft loss after transplantation. In Japan, pancreases available for transplantation are frequently from marginal donors due to diverse backgrounds in the population. However, marginal tissues increase the risk of early thrombosis in the graft.
CASE REPORT: Here, we describe a 41-year-old woman with type 1 diabetes mellitus who underwent a simultaneous pancreas-kidney transplantation. The pancreas was retrieved from a 34-year-old man who had experienced severe hemodynamic instability. The pancreaticoduodenal graft was implanted in the recipient iliac fossa with enteric drainage. Although the patient had not shown any physical signs or alterations in substances that might indicate functional loss of the pancreas graft, a Doppler ultrasound analysis detected a major thrombus in the pancreas graft on day 7 after surgery. A thrombectomy was performed with a radiological emergent intervention. After percutaneous direct thrombolysis, the patient received adjuvant thrombolytic therapy. Thereafter, the postoperative course was uneventful and the pancreas graft remained functional.
CONCLUSIONS: Early detection and treatment of thromboses are required to avoid graft failure and graft pancreatectomy. This case study demonstrates that early detection of severe thrombus with Doppler ultrasound in a grafted pancreas did not increase the risk of graft failure.
Keywords: Graft Survival, Pancreas Transplantation, Radiology, Interventional, Thrombosis, Ultrasonography, Doppler, Color